Using traditional or flipped classrooms to teach “Geriatrics and Gerontology”? Investigating the impact of active learning on medical students’ competences

Abstract

Background: The present study aims to investigate the effect of two educational strategies to teach geriatrics (flipped classroom-FL and traditional lectures-TR) in relation to a control group (no intervention) on students’ competences.

Method: An intervention study was conducted during the third year of medicine. Two different educational strategies (flipped classroom and traditional lectures) were incorporated into a theoretical–practical discipline of geriatrics. Students were evaluated about their attitudes towards older persons (Maxwell–Sullivan, UCLA geriatric attitudes), empathy (Maxwell–Sullivan), knowledge (Palmore and cognitive knowledge), skills (standardized patient assessment), and satisfaction with the activities.

Results: A total of 243 students were assessed. The FL group demonstrated greater gains in knowledge among students and improved attitude compared to the TR. We found no differences in the skills using a standardized patient. In addition, students exposed to FL felt more prepared to treat older people, believed they had more knowledge, were more satisfied, and evaluated the discipline’s format better in relation to the traditional group.

Conclusions: Strategies in teaching geriatrics can impact students’ knowledge, attitudes, and satisfaction with the course. We found that the way this teaching is delivered can influence students’ learning, since there were differences between active and traditional strategies.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Standardized Patient (SP): Individuals who have been trained to reliably reproduce the history and/or physical findings of typical clinical cases. They can be real patients who have been "standardized" or they can be simulated patients, i.e. persons who are not sick but take on a patient's history and role. Sometimes health care providers or actors are used to accomplish this goal. This tool is designed to make examination and assessment of a student's clinical skills as objective as possible. To teach a standardized patient to simulate a new clinical problem takes eight to ten hours.

Wojtczak A. 2003. Glossary of Medical Education Terms. AMEE Occasional Paper No 3. Dundee: AMEE.

Competence: Possession of a satisfactory level of relevant knowledge and acquisition of a range of relevant skills that include interpersonal and technical components at a certain point in the educational process. Such knowledge and skills are necessary to perform the tasks that reflect the scope of professional practices. Competence may differ from "performance", which denotes actions taken in a real life situation. Competence is therefore not the same as "knowing" on the contrary, it may well be about recognizing one's own limits. The more experienced the professional being tested, the more difficult it is to create a tool to assess their actual understandings and the complex skills of the tasks they undertake. A holistic integration of understandings, abilities and professional judgments, i.e. a “generic” model, is one where competence is not necessarily directly observable, but rather can be inferred from performance.

Wojtczak A. 2003. Glossary of Medical Education Terms. AMEE Occasional Paper No 3. Dundee: AMEE.

Flipped Classroom: The “Flipped Classroom” refers to an approach to teaching where the traditional class-time and self-study activities are reversed or “flipped”. In practice activities can take many forms, but generally involve students preparing for class by watching a prerecorded lecture or undertaking assigned reading and activities, followed by the “lecture” time being used for interactive discussion, problem-solving and other activities with the teacher. As such the role of the teacher shifts from being the “sage on the stage” to the “guide on the side”.

Advantages of this approach include: an increase in interaction between students and teachers; a shift in the responsibility for learning on to students; the ability for students to prepare at a time that suits them, and as many times as meets their needs; an archive of teaching resources; collaborative working between students; an increase in student engagement and a shift from passive listening to active learning. 

Possible disadvantages include: the need to invest time and resources to develop courses; the possible need for technological investment; and time for both teachers and students to adapt and acquire the new skills required for this more active and self-directed approach to learning.

Key to the success of this approach is that students take responsibility for their learning and come to class prepared. This can be seen as both an advantage and a disadvantage.

This approach has been credited to two US maths teachers, Aaron Sams and Jonathan Bergmann. However, parallels to this approach can be seen in Team-Based Learning, and distance learning higher education programmes, such as The Open University in the UK.

Bergman J., Overmyer J, Wilie B. 2011. “The Flipped Class: What it is and What it is not” The Daily Riff http://www.thedailyriff.com/articles/the-flipped-class-conversation-689.php (Accessed 09/05/13)

Notes on contributors

Alessandra Lamas Granero Lucchetti, MD, PhD is a medical doctor specialized in the care of the elderly. Received her PhD degree in health from the Federal University of Juiz de Fora, Brazil. She is currently an Assistant Professor of Medicine at the Federal University of Juiz de Fora, Brazil

Oscarina da Silva Ezequiel, MD, PhD is a medical doctor specialized in medical education and former FAIMER fellow. She is currently an Associate Professor of Medicine at the Federal University of Juiz de Fora, Brazil

Isabella Noceli de Oliveira is a medical student from the Federal University of Juiz de Fora, Brazil

Alexander Moreira-Almeida, MD, PhD is a medical doctor with fellowship training in Psychiatry, and received his PhD in Psychiatry from the University of São Paulo. He is an Associate Professor of Medicine at the Federal University of Juiz de Fora, Brazil.

Giancarlo Lucchetti, MD, PhD is a medical doctor with fellowship training in Geriatrics, and received his PhD in Neurology/Neurosciences from the Federal University of São Paulo. He is an Associate Professor of Medicine at the Federal University of Juiz de Fora, Brazil.

Additional information

Funding

This work was supported by Brazilian National Council for Scientific and Technological Development?Conselho Nacional de Desenvolvimento Científico e Tecnologico (CNPq) (Grant number 425074/2016-1).